WEBVTT - Decoding Cannabis with Dr. Staci Ann Gruber 0:00:17.130 --> 0:00:25.329 Pushkin. Hi everyone, Doctor Poyter here, I'm popping in to 0:00:25.410 --> 0:00:28.010 let you know that we're working on a special episode 0:00:28.050 --> 0:00:32.010 of Decoding Women's Health. We're i'll be answering your questions 0:00:32.089 --> 0:00:36.370 about one of my favorite topics, hormone therapy. If you've 0:00:36.409 --> 0:00:39.650 been wondering about the different types of therapy, when it 0:00:39.729 --> 0:00:43.610 might make sense to start possible side effects? Are really 0:00:43.650 --> 0:00:47.370 anything else? This is your chance to ask. You can 0:00:47.449 --> 0:00:50.690 leave us a voicemail at four FI five two one 0:00:51.210 --> 0:00:54.930 three three eight five, or send an email to Decodingwomen's 0:00:54.930 --> 0:00:57.889 Health at Pushkin dot fm and let us know if 0:00:57.890 --> 0:00:59.810 you'd like to stay anonymous, or if you're up for 0:00:59.850 --> 0:01:02.929 having your voice featured on the show. I'm so excited 0:01:02.970 --> 0:01:06.250 for this one. Hormone support is such a misunderstood area 0:01:06.290 --> 0:01:09.130 of medicine, and there's a ton of new and fascinating 0:01:09.130 --> 0:01:12.370 research to talk about together. I can't wait to hear 0:01:12.410 --> 0:01:14.569 what you're curious about. 0:01:14.930 --> 0:01:17.050 Our first paper. They said, aren't you worried that these 0:01:17.050 --> 0:01:19.450 are people who are just looking to be high but 0:01:19.570 --> 0:01:22.410 stay within the limits of the law. No, I'm not, 0:01:22.810 --> 0:01:25.210 because most people that I deal with do not want 0:01:25.250 --> 0:01:28.490 to be intoxicated. We have a clinical trial for endometriosis. 0:01:28.490 --> 0:01:30.370 And the very first thing almost every one of them 0:01:30.370 --> 0:01:31.650 has said to me is it's not going to get 0:01:31.690 --> 0:01:34.330 me high, right, first thing, end of the box. Because 0:01:34.530 --> 0:01:36.890 people have whole lives. They have work, they have children, 0:01:36.890 --> 0:01:40.290 they have activities, they have partners, they have school lunches, 0:01:40.330 --> 0:01:42.450 they have dinner dates, they have things. They don't want 0:01:42.490 --> 0:01:45.090 to be high all day, every day. 0:01:46.130 --> 0:01:49.250 Welcome to Decoding Women's Health. I'm doctor Elizabeth Poynter, and 0:01:49.290 --> 0:01:53.010 today on the show, we're talking cannabis. You know, medical 0:01:53.010 --> 0:01:56.090 marijuana first came on my radar about ten years ago 0:01:56.530 --> 0:01:59.090 when it first became legal in the states where I practiced. 0:01:59.770 --> 0:02:02.650 That meant as a doctor and as a surgeon, I 0:02:02.690 --> 0:02:06.010 had another treatment option to explore for my patients who 0:02:06.010 --> 0:02:10.210 were dealing with pelvic pain, endometriosis, and other chronic pain issues. 0:02:11.130 --> 0:02:13.930 The patients that I referred to medical dispensaries generally had 0:02:13.970 --> 0:02:18.010 positive experiences, and over time, more and more of the 0:02:18.050 --> 0:02:20.970 women I treated began sharing that they were using cannabis 0:02:20.970 --> 0:02:24.209 for other conditions, not just for their pain, but also 0:02:24.329 --> 0:02:29.169 for psychological issues like anxiety and depression. This was many 0:02:29.250 --> 0:02:32.890 years ago now, and so much has changed. Access to 0:02:32.929 --> 0:02:36.809 these products has exploded in recent years as more states 0:02:36.889 --> 0:02:42.210 legalized both recreational and medical marijuana. So before recording today's interview, 0:02:42.290 --> 0:02:45.609 I did some homework. I reviewed the latest medical cannabis 0:02:45.609 --> 0:02:49.049 research from top journals, and for the very first time, 0:02:49.090 --> 0:02:53.650 I visited my own local dispensary. It was totally overwhelming. 0:02:53.769 --> 0:02:57.609 There were so many options. The sales representative or bud 0:02:57.690 --> 0:03:00.529 tender as I learned that she was called, was kind 0:03:00.609 --> 0:03:03.450 and tried to be helpful, but she seemed to struggle 0:03:03.489 --> 0:03:05.730 to answer some of the more specific questions that I 0:03:05.810 --> 0:03:08.329 had about what products might be the best for certain 0:03:08.370 --> 0:03:12.130 symptoms and conditions. For many women, and exploring this world 0:03:12.130 --> 0:03:14.610 for the first time, I can totally see how it 0:03:14.690 --> 0:03:16.929 might be very difficult to know what to ask for 0:03:17.410 --> 0:03:19.889 or how to proceed safely in a way that addresses 0:03:20.090 --> 0:03:25.330 your individual health needs. Fortunately, today we have an exceptional 0:03:25.410 --> 0:03:28.450 guide to walk us through all of this. My guest 0:03:28.530 --> 0:03:32.970 is doctor Stacey Gruber. She's a neuroscientist and an international 0:03:33.049 --> 0:03:36.210 expert on the health effects of marijuana. This made me 0:03:36.290 --> 0:03:40.810 do a deep dive into the science of the connabinoid pathway. 0:03:41.250 --> 0:03:44.570 Super curious here and it's constantly changing what we know 0:03:44.650 --> 0:03:46.730 today is different from what we'll know tomorrow. You know, 0:03:46.770 --> 0:03:48.570 people used to think these things worked one way, and 0:03:48.650 --> 0:03:50.770 they don't. So there's never a dumb moment. 0:03:50.970 --> 0:03:53.850 That's the great thing about science. If you believe in science, 0:03:54.130 --> 0:03:57.850 I agree with you. Yes, yeah, that's a whole another episode. 0:04:00.010 --> 0:04:03.010 Doctor Gruber is the creator and the director of the 0:04:03.050 --> 0:04:08.330 Marijuana Investigations for a Neuroscientific Discovery, or the MIND Program, 0:04:08.410 --> 0:04:11.810 at McClain Hospital. She's also in a so Sociate Professor 0:04:11.810 --> 0:04:16.650 of Psychiatry at Harvard Medical School. The overarching goal of 0:04:16.690 --> 0:04:20.610 her research is to understand how medical cannabis affects individuals 0:04:20.650 --> 0:04:24.450 over time. She and her team study how cannabis use 0:04:24.610 --> 0:04:31.130 influences things like anxiety, depression, sleep, chronic pain, and reliance 0:04:31.170 --> 0:04:35.049 on other medications. They began observing people before they start 0:04:35.130 --> 0:04:38.050 using medical cannabis and then follow their progress for months 0:04:38.170 --> 0:04:41.450 and sometimes years to see how things change. 0:04:41.570 --> 0:04:45.570 In twenty fourteen, I launched the MIND Program because in 0:04:45.610 --> 0:04:48.810 twenty twelve, Massachusetts was on the precipice of legalizing cannabis 0:04:48.849 --> 0:04:52.210 for medical purposes, or I should say relegalizing cannabis was 0:04:52.289 --> 0:04:55.049 legal in this country. Was part of our US pharmacopeia 0:04:55.130 --> 0:04:57.890 it fell out of favor, became illegal, landed in the 0:04:57.930 --> 0:05:01.130 most restrictive class of the Controlled Substance Act. But in 0:05:01.210 --> 0:05:04.249 nineteen ninety six it was reintroduced in California for medical 0:05:04.250 --> 0:05:08.570 purposes and reapproved. So in twenty twelve, Massachusetts was about 0:05:08.610 --> 0:05:12.450 to approve cannabis for medical purposes, and I decided, let's 0:05:12.570 --> 0:05:14.609 look at the literature and see what we know about 0:05:14.610 --> 0:05:18.689 the long term effects of medical cannabis use. Scouring the literature, 0:05:18.690 --> 0:05:21.170 I found almost nothing, and so that's why I launched 0:05:21.170 --> 0:05:23.849 this program. There has never been a program dedicated to 0:05:23.890 --> 0:05:26.490 looking at the long term impact of medical cannabis use, 0:05:26.890 --> 0:05:29.849 despite the fact that it was relegalized in California in 0:05:29.890 --> 0:05:33.490 nineteen ninety six. Almost everything we know about cannabis has 0:05:33.490 --> 0:05:38.650 come from studies of recreational consumers, primarily young, healthy recreational consumers, 0:05:38.810 --> 0:05:40.810 and that's a bit of a problem. In fact, it's 0:05:40.849 --> 0:05:44.289 a huge problem. Individuals who are using for recreational purposes 0:05:44.409 --> 0:05:48.729 by design, are looking for products with notable THHC or tetrahydrocannabinol, 0:05:48.810 --> 0:05:52.850 the primary intoxicating constituent of the plant. In contrast, our 0:05:52.890 --> 0:05:56.169 medical cannabis patients aren't necessarily looking for that same experience. 0:05:56.210 --> 0:05:58.010 In fact, many will tell you I don't want to 0:05:58.010 --> 0:06:00.930 be altered or high. As a result, it's very challenging 0:06:00.969 --> 0:06:03.969 to really understand what the actual impact is on so 0:06:04.130 --> 0:06:08.130 many of these indications and conditions that people will swear uptown, 0:06:08.170 --> 0:06:12.170 left and right cannabis or cannabinoids are effect before. So 0:06:12.610 --> 0:06:16.130 since twenty fourteen, we've spent a lot of time doing 0:06:16.570 --> 0:06:20.450 longitudinal observational studies as well as some cross sectional studies 0:06:20.450 --> 0:06:22.929 and some survey studies, but mostly focused on the what 0:06:23.050 --> 0:06:25.849 is considered the holy grail getting to the clinical trial models, 0:06:25.890 --> 0:06:26.729 which is where we are. 0:06:27.210 --> 0:06:30.409 So it sounds like patients originally led you to look 0:06:30.450 --> 0:06:34.690 at cannabis. What particular aspect of it drew you into 0:06:34.930 --> 0:06:37.609 looking at cannabis other than the kind of lack of data. 0:06:37.810 --> 0:06:40.450 Was it you saw efficacy? Did you see people getting 0:06:40.450 --> 0:06:44.089 better using recreational cannabis? What did you observe that drew 0:06:44.130 --> 0:06:45.690 you into this area of research. 0:06:45.890 --> 0:06:48.010 So the first thing I would say is that going 0:06:48.050 --> 0:06:50.170 back to the sort of recreational days when I was 0:06:50.170 --> 0:06:52.690 still spending a lot of time in more general psychiatry, 0:06:53.050 --> 0:06:56.530 I noticed a very interesting trend. We spent a lot 0:06:56.570 --> 0:06:59.010 of time looking at patients with bipolar disorder, and I 0:06:59.010 --> 0:07:01.049 would hear patients say, you know, when I feel like 0:07:01.050 --> 0:07:03.490 I'm spiraling out of control, I take a few hits 0:07:03.570 --> 0:07:05.930 and I feel better. On the other side, you'd hear 0:07:05.969 --> 0:07:08.530 patients say, I feel so depressed and down. I take 0:07:08.529 --> 0:07:10.090 a few hits. I feel better. I had never heard 0:07:10.130 --> 0:07:12.610 of anything like this, and so this got me thinking, 0:07:12.810 --> 0:07:14.610 so we did a study. I wrote a grant to 0:07:14.730 --> 0:07:18.290 look at mood changes in individuals with bipolar disorder pre 0:07:18.370 --> 0:07:21.130 and post cannabis use, and we gave people little devices 0:07:21.170 --> 0:07:23.570 to chart their mood after every time they used cannabis 0:07:23.610 --> 0:07:25.570 and three other times a day. And we found that 0:07:25.650 --> 0:07:29.290 individuals with bipolar disorder who used cannabis actually had greater 0:07:29.610 --> 0:07:32.650 mood relief, if you will, from their symptoms relative to 0:07:32.690 --> 0:07:35.490 those patients with bipolar disorder who didn't use cannabis. What 0:07:35.530 --> 0:07:38.530 I was hearing was really individuals saying that they felt 0:07:38.530 --> 0:07:39.090 more stable. 0:07:39.330 --> 0:07:41.369 So it was working on both the manic side of 0:07:41.410 --> 0:07:43.370 the bipolar and the depressive side. 0:07:43.690 --> 0:07:46.490 It seemed too for certain people. So that got me thinking, 0:07:46.770 --> 0:07:51.690 how could something both provide relief from feeling hypomanic or 0:07:51.690 --> 0:07:54.090 manic and give you more of a little bit of 0:07:54.130 --> 0:07:56.490 a lift if you're feeling depressed. And I was desperate 0:07:56.530 --> 0:07:58.570 to understand how both could be true, how can we 0:07:58.650 --> 0:08:01.050 harness some of these things? And that's really how it began. 0:08:01.490 --> 0:08:04.770 And the truth is, cannabis is a remarkable plant with 0:08:04.810 --> 0:08:07.610 over five hundred compounds. You know, we have this tendency 0:08:07.650 --> 0:08:10.690 to say cannabis and we refer to any and all 0:08:10.730 --> 0:08:13.330 things the plant. But it's a missoe we shouldn't do that. 0:08:13.570 --> 0:08:16.250 It's not one thing and it's not one size fits all. Yeah, 0:08:16.330 --> 0:08:18.450 let's dig into that a little bit. Let's do cannabis 0:08:18.490 --> 0:08:20.690 one oh one for our listeners. Okay, so, can you 0:08:20.810 --> 0:08:23.890 just briefly explain the difference between cannabis and hemp, and 0:08:24.210 --> 0:08:27.570 cannabis and cannabinoids and kind of the important components, and 0:08:27.610 --> 0:08:30.250 just give us an overview of cannabis one oh one 0:08:30.250 --> 0:08:32.130 what we need to know cannabis one on one. I 0:08:32.130 --> 0:08:34.530 guess I would start by saying that Cannabis sativa l. 0:08:34.610 --> 0:08:37.890 The plant is remarkably complex. It is comprised of over 0:08:37.930 --> 0:08:41.410 five hundred compounds. Some of these are phytocannabinoids, things from 0:08:41.450 --> 0:08:44.250 the plant that interact with our own system of chemicals. 0:08:44.370 --> 0:08:47.650 Receptors throughout the brain and body the endocannabinoid system. These 0:08:47.650 --> 0:08:51.170 are things like delta nying THHC or tetrahydric canabinol, the 0:08:51.210 --> 0:08:54.809 primary intoxicating constituent of the plant that our recreational folks 0:08:54.850 --> 0:08:57.490 are desperate to find. No judgment, We're fine with them. 0:08:57.569 --> 0:08:59.570 That's what makes us high, right, The THHC. 0:08:59.450 --> 0:09:03.530 That's what makes you high, exactly, So primary intoxicating constituents 0:09:03.530 --> 0:09:06.890 of the plant. Cannabi diol or CBD is a primary, 0:09:06.929 --> 0:09:09.730 but not the only, non intoxicating constituent of the plant. 0:09:09.890 --> 0:09:11.410 Often touted for medical benefits. 0:09:11.569 --> 0:09:13.970 CBD is an anti inflammatory, right. 0:09:13.970 --> 0:09:16.890 CBD is touted for its anti inflammatory actions. It's also 0:09:16.929 --> 0:09:19.089 got lots of other actions, but yes, it's one of them. 0:09:19.210 --> 0:09:22.810 But there are literally dozens and dozens of other cannabinoids 0:09:22.850 --> 0:09:25.250 that we spend time focusing on. There are also things 0:09:25.330 --> 0:09:29.249 like terpenes, the essential oils that give cannabis its characteristic 0:09:29.370 --> 0:09:32.209 scent and flavor profile. These essential oils, by the way, 0:09:32.250 --> 0:09:35.850 present in every plant, have their own biobehavioral health effects. 0:09:35.890 --> 0:09:38.890 As it turns out, flabinoids waxy penal. So the plant 0:09:39.090 --> 0:09:42.969 is complex. It's not just THHC and CBD, as people 0:09:42.970 --> 0:09:47.370 will often pretend a whole plant. Full spectrum product contains 0:09:47.450 --> 0:09:50.410 everything from the native plant that made the product, so 0:09:50.450 --> 0:09:54.850 that's THC, cbd, any and all cannabinoids, terpenes, flabinoids, everything. 0:09:55.170 --> 0:09:58.650 A broad spectrum product is identical except that it has 0:09:58.770 --> 0:10:03.170 no quantifiable amounts of THHC present, again the primary intoxicating 0:10:03.170 --> 0:10:06.250 constituent of the plant. There are some people who, for 0:10:06.490 --> 0:10:10.090 legal or health reasons, cannot have any exposure to delta 0:10:10.130 --> 0:10:14.690 nine THHC, So broad spectrum products are like full spectrum products, 0:10:14.850 --> 0:10:18.890 except they don't contain quantifiable amounts of THHC. Hemp is 0:10:18.929 --> 0:10:22.089 a variety of cannabis with inherently low levels of delta 0:10:22.130 --> 0:10:25.490 nine THHC. It's often referred to as industrial hemp because 0:10:25.490 --> 0:10:29.210 it was used for industrial purposes. These are basically at 0:10:29.210 --> 0:10:32.209 this point excluded from the Controlled Substance Act, which means 0:10:32.210 --> 0:10:35.929 that products that are created from hemp are not under 0:10:35.970 --> 0:10:39.530 the same federal jurisdiction. That is, they are not federally illegal. 0:10:39.569 --> 0:10:43.570 If you will, as cannabis or quote marijuana is, can you. 0:10:43.569 --> 0:10:47.130 Speak to us a little bit about delivery systems, I mean, smoking, vaping, 0:10:47.970 --> 0:10:52.570 edible vaginal suppositories for pelvic pain s. 0:10:52.730 --> 0:10:55.689 Yes, all the above. Root matters. Think of it as 0:10:55.689 --> 0:10:58.370 a GPS like, it matters which way you go. So 0:10:58.410 --> 0:11:01.290 the fastest way to get an effect from using cannabis 0:11:01.490 --> 0:11:04.170 is or a cannabinoid based product is what I would 0:11:04.170 --> 0:11:07.450 call a root of inhalation, right, so either smoking or vaping, 0:11:08.090 --> 0:11:10.410 so we inhale, it goes into the lungs, into the bloodstream, 0:11:10.410 --> 0:11:12.090 into the brain. That's what I would call moments to 0:11:12.170 --> 0:11:16.050 minutes to get an effect. We use a sublingual delivery 0:11:16.050 --> 0:11:18.770 system for all of our clinical trials because the area 0:11:18.890 --> 0:11:21.770 just under the tongue, the salibary mucosa, is incredibly rich 0:11:21.809 --> 0:11:24.850 and absorbent, and instead of waiting for you to swallow 0:11:24.890 --> 0:11:26.809 something and digest it, which we're going to get to 0:11:26.850 --> 0:11:29.450 in a second, with edibles, your body can actually use 0:11:29.450 --> 0:11:33.450 it much more effectively, much more quickly. Edibles, whether that's 0:11:33.450 --> 0:11:35.890 a brownie or a cookie, or a candy, or even 0:11:35.890 --> 0:11:39.370 a beverage, although beverages are slightly faster anting than cookies 0:11:39.370 --> 0:11:42.569 and brownies. So this is the type of product that 0:11:42.730 --> 0:11:45.890 people are often very happy to explore. They think it's 0:11:45.890 --> 0:11:47.890 going to be terrific and they eat it or they 0:11:48.010 --> 0:11:49.690 drink it, and they wait what they feel is an 0:11:49.689 --> 0:11:51.809 appropriate amount of time, they don't feel anything, and then 0:11:51.809 --> 0:11:55.690 they have more. It takes a very long time, comparatively speaking, 0:11:55.689 --> 0:11:57.329 for you to get an effect from an edible or 0:11:57.370 --> 0:12:00.930 consumed product. That's because you have to digest it. Interestingly, 0:12:01.010 --> 0:12:03.730 cannabinoids are processed then by the liver. Your liver process 0:12:03.809 --> 0:12:07.290 is all compounds, all drugs, right, and things like delta 0:12:07.370 --> 0:12:11.490 nine THHC. The primary intoxicating considering of the plant is 0:12:11.530 --> 0:12:15.330 actually converted to something even more intoxicating, eleven hydroxy. I 0:12:15.370 --> 0:12:18.250 always tell people hold on root of administration is important. 0:12:18.250 --> 0:12:20.330 If you're eating it, you have to give yourself plenty 0:12:20.370 --> 0:12:23.650 of time to feel the effect and to recover from 0:12:23.730 --> 0:12:26.210 the effect. Isn't the same as smoking or vaping, where 0:12:26.210 --> 0:12:27.850 it's almost immediate. 0:12:27.650 --> 0:12:30.729 Any damage to the lungs with us smoking. So you know, 0:12:30.770 --> 0:12:34.330 there's a lot of dispute about this, and the twenty 0:12:34.370 --> 0:12:37.730 seventeen Nason Report, the National Academies of Science Engineering in 0:12:37.770 --> 0:12:41.170 Medicine looked at what indications or conditions there might be real, 0:12:41.290 --> 0:12:44.650 substantial or moderately significant evidence for it with regard to 0:12:44.689 --> 0:12:48.090 cannabis being efficacious, and they did review things like head 0:12:48.130 --> 0:12:52.410 and neck cancers, and the rates were not significantly higher necessarily. 0:12:52.569 --> 0:12:54.850 I think it's early still to figure that out. And 0:12:54.970 --> 0:12:59.610 really most people acknowledge that the amount of cannabis that 0:12:59.610 --> 0:13:01.850 people are smoking or vaping and the ways in which 0:13:01.850 --> 0:13:03.570 they're doing it may be very different from things like 0:13:03.610 --> 0:13:06.050 cigarette smoking, So maybe that's one of the differences. But 0:13:06.929 --> 0:13:10.290 there's lots of debate about the carcinogenic compounds and what's contained, 0:13:10.290 --> 0:13:12.210 so I think we don't know the whole story yet 0:13:12.330 --> 0:13:14.970 for sure. But there are people who would prefer to 0:13:15.050 --> 0:13:18.329 use a root of inhalation, so smoking or vaping. Dabbing, 0:13:18.330 --> 0:13:20.570 of course, is another where people take a very very 0:13:20.610 --> 0:13:28.130 concentrated Bullus concentrates are exactly as their name suggests, designed 0:13:28.130 --> 0:13:30.850 to give the consumer or patient a big bang for 0:13:30.929 --> 0:13:34.450 the buck. These are primarily THHC focused and start at 0:13:34.450 --> 0:13:36.890 about forty five or fifty percent PhD and go north 0:13:36.890 --> 0:13:38.730 of ninety nine percent. How do you dab? 0:13:39.130 --> 0:13:41.010 So, in the case of an actual quote dab this 0:13:41.050 --> 0:13:44.850 little blob of very concentrated product, you actually need something 0:13:45.450 --> 0:13:47.490 that you can get very very hot with a blowtorch. 0:13:47.569 --> 0:13:49.650 It doesn't look anything like conventional cannabis. 0:13:49.770 --> 0:13:49.890 Use. 0:13:49.970 --> 0:13:51.809 Like when we think about people passing a blunt or 0:13:51.809 --> 0:13:53.730 a spliff or a joint or something, or a bong. 0:13:54.330 --> 0:13:56.290 You see people with a little blowtorch and a little 0:13:56.689 --> 0:13:59.570 flat area. They get very very hot, and as soon 0:13:59.610 --> 0:14:03.290 as they put this little tiny blob of very concentrated 0:14:03.290 --> 0:14:05.569 product on it, they inhale. They get this giant bulus 0:14:05.569 --> 0:14:07.970 all at once. Then we get to the you know 0:14:08.010 --> 0:14:11.770 sort of we had the oromycoastal or transmucostal. So things 0:14:11.809 --> 0:14:15.570 like suppositories vaginal or rectal people are using for more 0:14:15.610 --> 0:14:18.850 localized relief, and they do seem to be efficacious for 0:14:19.010 --> 0:14:21.970 some folks. For some things, we never see recreational folks 0:14:22.010 --> 0:14:24.890 using suppositors. I will tell you if you had to 0:14:24.930 --> 0:14:27.890 come across a recreational purssses, yeah, that's my favorite way. 0:14:28.010 --> 0:14:29.010 Now nobody says that. 0:14:29.170 --> 0:14:32.170 No, how about for enhancement of sexual pleasure? Do you 0:14:32.210 --> 0:14:34.370 see that? Yes, vaginal suppositories. 0:14:34.410 --> 0:14:37.530 I think vaginal suppositories began as a way of increasing 0:14:37.610 --> 0:14:41.890 pleasure and increasing lubrication and decreasing discomfort from many many 0:14:41.890 --> 0:14:46.050 individuals who are having any kind of discomfort around sex. 0:14:46.090 --> 0:14:48.450 And it was also initially tattered as a way of 0:14:48.490 --> 0:14:50.250 you know, sort of getting yourself in the mood. But 0:14:50.770 --> 0:14:52.890 at this point we certainly see a number of products 0:14:52.890 --> 0:14:57.330 in the marketplace designed to address or ameliorate symptoms relative 0:14:57.450 --> 0:15:01.810 to meastural related discomfort or other types of discomfort, as 0:15:01.850 --> 0:15:04.370 well as enhancing sexual pleasure. And then there's the daily 0:15:04.490 --> 0:15:08.130 suppositories for women quote of a certain age. As time 0:15:08.170 --> 0:15:11.290 marches on, right, lots of people experience the things like 0:15:11.370 --> 0:15:14.210 vaginal dryness, so some of these oppositors are used on 0:15:14.250 --> 0:15:16.250 a daily basis, or oils are used. 0:15:16.610 --> 0:15:19.530 So what are you finding And let's just speak a 0:15:19.570 --> 0:15:22.410 little bit about midlife women, right, do you see a 0:15:22.530 --> 0:15:26.850 number of midlife women using cannabis for medical reasons and 0:15:26.930 --> 0:15:29.370 not recreational reasons? And if they are, what are they 0:15:29.450 --> 0:15:33.090 using it for? Hot flashes, mood disruptions, sleep anxiety. 0:15:33.410 --> 0:15:35.730 So the answer to both those questions is yes, yes, 0:15:35.770 --> 0:15:38.850 and yes. The top three indications for medical cannabis use 0:15:38.890 --> 0:15:42.290 across the country are chronic pain, mood or anxiety, and 0:15:42.290 --> 0:15:46.250 sleep disruption. Not surprisingly, these are the three top conditions 0:15:46.250 --> 0:15:50.650 we hear about in individuals who are either perimenopausal or postmenoposal, 0:15:50.850 --> 0:15:55.610 so that's not a surprise. Individuals are increasingly interested in 0:15:55.730 --> 0:15:59.290 using cannabis or cannabinoid based therapies to help because they 0:15:59.290 --> 0:16:04.370 have very limited treatment options currently and very limited clinical response. 0:16:04.410 --> 0:16:07.090 As it turns out, those who get clinical response from 0:16:07.130 --> 0:16:11.050 certain conventional medications often complain about side effects, and the 0:16:11.090 --> 0:16:13.330 cannabis or cannabinoids they may be able to reduce or 0:16:13.410 --> 0:16:16.970 completely eliminate that aspect from the equation, which is pretty amazing. 0:16:17.170 --> 0:16:21.290 So you started the Mind program, you have the Women's 0:16:21.290 --> 0:16:24.490 Health Initiative within the Mind program. Can you tell me 0:16:24.770 --> 0:16:27.090 what kind of questions you're trying to answer with that? 0:16:27.290 --> 0:16:30.170 What are your goals? Where are you moving with that? 0:16:31.210 --> 0:16:36.210 I didn't realize what a vastly understudied population we are. 0:16:36.330 --> 0:16:38.370 I didn't. I really didn't. I didn't think about it. 0:16:38.890 --> 0:16:41.650 You know, in psychiatry we think about things that are 0:16:41.690 --> 0:16:45.250 disproportionately higher in women than men, like anxiety disorders. Right, 0:16:45.810 --> 0:16:48.330 things like dementia occur in women more often than in men. 0:16:48.570 --> 0:16:50.290 We have all of these things that we need to 0:16:50.330 --> 0:16:52.810 be mindful of. Guide Ecologic pain, by the way, affects 0:16:52.810 --> 0:16:57.050 over one billion with a b B one billion, and 0:16:57.330 --> 0:17:00.170 we do relatively little, or we've had relatively little in 0:17:00.250 --> 0:17:03.250 terms of these giant discoveries in terms of allowing people 0:17:03.290 --> 0:17:05.410 to be better and not just feel better, but actually 0:17:05.450 --> 0:17:08.690 be better. Women or the Women's Health Initiative at MIND 0:17:08.770 --> 0:17:11.650 was a program that was dedicated to looking at conditions 0:17:11.690 --> 0:17:15.889 or disorders that either disproportionately or exclusively affect women or 0:17:15.930 --> 0:17:20.290 some non binary folks. Because there's so little work. 0:17:20.170 --> 0:17:24.130 In this area, Stay right there. We've got lots more 0:17:24.170 --> 0:17:26.970 from my conversation with doctor Stacey Gruber. Coming right up, 0:17:42.170 --> 0:17:45.650 Can you describe a little bit about the endocannabinoid pathway 0:17:45.810 --> 0:17:50.050 in the human body and how cannabisc and CBD are 0:17:50.050 --> 0:17:51.490 impacting these pathways? 0:17:51.810 --> 0:17:54.770 Sure, I would say it very sort of. The overarching, 0:17:54.930 --> 0:17:57.689 you know, ten thousand foot summary is that every mammal 0:17:57.690 --> 0:18:02.090 has an endocannabinoid system, highly understudied, highly undervalued, and its 0:18:02.170 --> 0:18:05.050 whole purpose really is what we call homeostasis. We're keeping 0:18:05.090 --> 0:18:09.129 things in balance, in check, mood, appetite, pain, all of 0:18:09.129 --> 0:18:12.810 these things are impacted by the end cannabinoid system, and 0:18:13.010 --> 0:18:16.210 it's comprised of these chemicals and receptors. And for chemicals, 0:18:16.330 --> 0:18:19.410 they're our own cannabinoids. En do cannabinoids, and we have 0:18:19.570 --> 0:18:23.050 receptors including CB one and CB two receptors. CB one 0:18:23.090 --> 0:18:26.330 receptors primarily throughout the central nervous systems, CB two receptors 0:18:26.330 --> 0:18:30.570 throughout the periphery. And it appears that THHC is really 0:18:30.570 --> 0:18:32.889 a very very strong agonist, that is, it binds very 0:18:32.890 --> 0:18:34.929 effectively to CB receptors. 0:18:35.050 --> 0:18:38.010 So the CB two receptors are all throughout our body, correct, 0:18:38.050 --> 0:18:39.930 not just our central nervous system. 0:18:39.850 --> 0:18:41.970 Throughout the periphery, right, So you know, you see CB 0:18:42.050 --> 0:18:45.050 two receptors sort of everywhere else a few in the brain, 0:18:45.090 --> 0:18:48.010 but not like CB one receptors, And that may be 0:18:48.090 --> 0:18:50.969 one of the reasons that initially people were rather stunned 0:18:51.010 --> 0:18:54.929 to see that things like Crohn's disease, INFLAMMATORID bowel disease 0:18:55.290 --> 0:18:59.449 were responsive to different types of cannabinoid based therapies. Not all, 0:18:59.850 --> 0:19:02.570 not all cannabinoids are created equally, and we have to 0:19:02.609 --> 0:19:06.050 be mindful with some actions come reactions, and so it's 0:19:06.090 --> 0:19:09.449 very important to know which cannabinoids for which types of indications, 0:19:09.450 --> 0:19:14.730 in which patient populations. And until relatively recently, we were 0:19:15.090 --> 0:19:19.129 under the impression that cannabidial or CBD also must exert 0:19:19.170 --> 0:19:21.649 its effects through the CB one and CB two receptors. 0:19:21.810 --> 0:19:24.570 As it turns out it's not true. It appears that 0:19:24.690 --> 0:19:28.490 CBD modulates its effects through five ht one A or 0:19:28.530 --> 0:19:33.250 serotonin receptors, other chemical and receptor systems. So it's really 0:19:33.369 --> 0:19:35.490 very easy to understand then how you get a bigger 0:19:35.530 --> 0:19:38.010 bang for the buck with more quote players on the field. 0:19:38.330 --> 0:19:41.130 If you're involving more than one receptor subtype and chemical 0:19:41.250 --> 0:19:44.410 messenger system, you're going to get more of a response. 0:19:44.490 --> 0:19:47.010 Right and medical school, we don't spend a ton of 0:19:47.050 --> 0:19:50.409 time thinking about the endocannabinoid system. Nobody hears about it, 0:19:50.450 --> 0:19:52.930 but it turns out to be incredibly important. Again, when 0:19:52.930 --> 0:19:55.730 I think of it, I think as keeping everything in balance, 0:19:56.210 --> 0:20:00.010 your ability to keep things at status. Quote, that's its 0:20:00.250 --> 0:20:02.929 entire goal. That's the endocannabinoid system. 0:20:03.490 --> 0:20:06.010 Can you just give us a broad overview of how 0:20:06.129 --> 0:20:09.850 cannabis is impacting the brain for an axiolytic effect or 0:20:10.129 --> 0:20:12.169 a pain of fact and that type of thing, like 0:20:12.210 --> 0:20:15.209 what is it actually doing in the central nervous system 0:20:15.330 --> 0:20:17.170 to help our anxiety, to help our pain? 0:20:17.450 --> 0:20:19.929 I think that the jury is absolutely still out with 0:20:19.970 --> 0:20:23.530 regard to the specific absolute mechanisms, because so many different 0:20:23.530 --> 0:20:26.609 types of products wind up being efficacious, and those different 0:20:26.609 --> 0:20:29.929 types of products have different constituent profiles, and so you 0:20:29.970 --> 0:20:33.050 can't necessarily know exactly. Okay, well, we know it's this 0:20:33.090 --> 0:20:35.010 receptor system in this one of this one, and I 0:20:35.050 --> 0:20:37.449 tend to think of us as being comprised of dials 0:20:37.490 --> 0:20:39.369 and not switches, right, what we really want to do 0:20:39.850 --> 0:20:42.810 in individuals who are anxious, and I will tell you 0:20:42.890 --> 0:20:45.610 in general, when we can allow people to take an 0:20:45.609 --> 0:20:50.330 emotional breath dial down that master gain. Everything begins to 0:20:50.369 --> 0:20:52.290 fall into place. And so I think of all of 0:20:52.330 --> 0:20:54.850 these things, whether it's anxiety or some of the other 0:20:54.930 --> 0:20:58.649 mood related symptoms, but particularly for anxiety, it would appear 0:20:58.730 --> 0:21:02.330 that higher levels of CBD being administered in our case 0:21:02.770 --> 0:21:06.130 sublingually where people are holding for two full minutes, that's 0:21:06.170 --> 0:21:09.850 the secret two full minutes multiple times a day, very 0:21:09.890 --> 0:21:12.609 low to no levels of depending on what we're doing, 0:21:13.250 --> 0:21:16.369 we do tend to see this down regulation right of 0:21:16.410 --> 0:21:20.970 this hyper responsive activity. The real data will come when 0:21:20.970 --> 0:21:23.850 we can actually look at the underlying change in what 0:21:23.890 --> 0:21:27.690 we call endocannabinoid tone. So when you can take samples 0:21:27.690 --> 0:21:30.730 of individuals before they use these products and then follow 0:21:30.770 --> 0:21:33.170 them over time and look at how that changes, we'll 0:21:33.170 --> 0:21:36.129 have a better sense of exactly what's happening, but I 0:21:36.250 --> 0:21:39.050 like to think of it as again turning down this 0:21:39.330 --> 0:21:42.650 unbelievable response system. And people with real anxiety will tell 0:21:42.690 --> 0:21:45.689 you it is paralyzing. They can't get out of it, 0:21:45.730 --> 0:21:49.690 they can't stop ruminating, and so this ability to sort 0:21:49.690 --> 0:21:54.369 of allow them to shift cognitive set is hugely life changing. 0:21:54.810 --> 0:21:57.650